A mediational model of quality of life for individuals with severe mental health problems

BACKGROUND: Despite the increasing importance of quality of life in the mental health field, the theoretical conceptualization of the construct remains poorly developed. A proposed mediational model of quality of life, which links subjective quality of life with self-related constructs, is examined with a group of long-term psychiatric hostel residents. The present study aims to develop a measure of quality of life based on the proposed model, to explore the data and their implications for service development and finally to conduct a preliminary analysis of the model's predictions. METHODS: A cross-sectional research design was employed. Quality of life interviews, using a modified version of Lehman's Quality of Life Interview, were carried out with 54 psychiatric residents in Greece. The model's predictions were examined by using a series of regression analyses. RESULTS: The results indicate that perceived improvements in lifestyle, greater autonomy and positive self-concept are significantly and directly associated with better quality of life. In contrast, a direct relationship between objective indicators and subjective quality of life was not found. CONCLUSIONS: The traditional two-part quality of life model that includes objective indicators of life circumstances and subjective indicators is extended to included the constructs of self-concept and perceived autonomy. The present extended mediational model of quality of life for individuals with long-term mental health problems appears to have important implications for the planning and delivery of mental health programmes.     

A multiplicative model of the utility of survival duration and health quality.

We investigate the hypothesis that the utility (subjective value) of survival duration and health quality is determined by a multiplicative model. According to this model, there are separate subjective scales for the utility of survival duration and health quality. A critical prediction of the multiplicative model is the hypothesis that preferences between gambles for health outcomes satisfy a property called utility independence. After defining this property and explaining how it can be tested in behavioral data, we report an experimental test of whether the health preferences of medical patients satisfy utility independence. Individual analyses revealed that most subjects satisfy utility independence. Some subjects appear to violate a fundamental assumption of utility theory, that a single utility scale represents both the ordinal preference relations between certain outcomes and the subjective averaging that underlies the utility of gambles. The violation is inferred from an inconsistency between preferences for multiattribute outcomes when they are viewed as certain outcomes and when they are viewed as the outcomes of gambles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The evolution of the thought of "Yojo" and its function as a theoretical bases for development of health culture

The purpose of this monograph is to clarify the role of "Yojo" on public health in Japan. Yojo is a traditional concept which has been used for the nourishment of life in Eastern cultures. These thoughts on Yojo were published under the title of Yojoron in ancient China. Yojoron was imported into Japan somewhere from the 7th to 10th centuries. In ancient and medievel Japan, there were few writings about Yojoron. However during the Edo period, Yojoron suddenly flourished. Dominant in Yojoron was diet. Issues such as exercise, mental control, and sexual restraint were also considered in the Bunka, Bunsei, and Tenpo periods (the first half of 19th century). Yojoron included not only matters of physical and mental health but various other matters regarding the general quality of life such as morality, domestic economy, culture and education. However other health-related issues such as longevity and absence of diseases, showed a simultaneous decrease in the importance. Also principles of Yojoron such as restraint and austerity in behaviour were liberalized. These trends indicated the basic shift in Yojoron from personal health care to self-culture for the entire quality of life. Writings on Yojoron were still published after the Meiji restoration (1868). The principle of Yojoron in the Meiji period was based on both social Darwinism and social revolution theories. The primary concerns of Yojoron were consolidated into achieving health and longevity by personal effort. Therefore Yojoron can be seen as the theory of lifestyle and quality of life in traditional societies in Japan. The public saw in Yojoron a design for living through improved health. This meant the Yojoron was a very refined art of living, and therefore, implies that health care should be integrated with entire self-development. The principle of Yojo offers the ideal foundation of 'health culture' in modern societies.     

Quality of life. Issues for persons with neuromuscular diseases

Improving quality of life has always been a goal of rehabilitation medicine. However, health care providers often do not know much about the quality of life of individuals with neuromuscular diseases, nor what factors are critical to achieving a good quality of life. Lack of knowledge about subjective quality of life factors can negatively influence expectations and selection of treatments. In the most glaring cases, a physician's subjective but incorrect assessment of a disabled individuals' quality of life may prevent life-sustaining interventions. As a group, the quality of life of individuals with NMD is not much different than nondisabled controls and is substantially better than presumed by the general public and, often times, by health care workers. Nevertheless, their quality of life is reduced in certain areas. Surprisingly, level of disability is not a critical factor that significantly alters life satisfaction. Presumably, this is because physical functioning has been adequately managed. The greatest problems that individuals with neuromuscular disease identified were: lack of information about the disease and services; poor coordination of services; negative attitudes; and a diminished expectation of their potential. In addition, people with severe disabilities had significant problems obtaining, financing, and managing personal care attendants. Factors related to a good quality of life were related to perceived control, perceived health status, but not disability. The more that people could do for themselves, either on their own or with personal care assistants, assistive devices, and use of technology, the better their quality of life.     

Quality of life before and after liver transplantation for cholestatic liver disease

Liver transplantation (LT) is an established therapy for patients with end-stage primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC). In this report, we describe the health status and quality of life (QOL) in patients with these cholestatic liver diseases before and after LT. A QOL questionnaire was completed by 157 adult patients with PBC or PSC before and 1 year after liver transplantation at the Mayo Clinic or Baylor University Medical Center. This questionnaire measured four aspects of QOL, including symptoms; physical, social, and emotional functioning; health perceptions; and overall QOL. Changes in these QOL parameters before and after LT were described, and regression analysis was used to assess the relationships between clinical and QOL factors. There were no differences in QOL parameters between patients with PBC and PSC. QOL following transplantation was substantially better than before transplantation. This was observed in all four aspects of QOL. The degree of improvement as measured by effect size (difference in mean scores divided by the pretransplantation standard deviation) was 0.53 for symptoms (P <.01), 1.16 for function (P <.01), 2.37 for health satisfaction (P <.01), and 1.16 for overall QOL (P <.01). Patients' overall QOL before transplantation was significantly related to subjective and objective health status indicators and clinical factors such as ascites and renal dysfunction. QOL at 1-year follow-up, however, could not be adequately predicted by the pretransplantation subjective health status and clinical factors. Patients with end-stage cholestatic disease undergoing LT experience substantial improvement in all aspects of QOL addressed in this study. The patients' QOL 1 year after LT could not be predicted by pretransplantation variables used in this study.     

Myers-Briggs Type Indicator and dental school performance

Complex interactions between long-standing lifestyles and genetic factors are strongly involved in the pathologenesis of adult diseases or chronic degenerative diseases. We usually use a questionnaire to obtain life-style information from subjects in a health survey. However, the response to questionnaires is a subjective recognition, therefore, it does not always precisely correspond to the actual situation. The purpose of this research is to compare the response to the questionnaire about life-styles with facts that can be objectively observed. Furthermore, each aspect of life-styles was examined on a mutual influence grade. The subjects were ninety-eight nursing college students aged from 18 to 23 years old, in good health. Subjective symptoms and daily life practices were investigated by a 15-item questionnaire, as the first step. Therefore, we asked them to record their behavior on a time chart, everyday for ten days. Seven days of serial records were obtained from sixty-four subjects (65.3% of 98 persons). 1) The response "yes" to the questionnaire "Do you sleep well?" and "Do you fall asleep, easily?" was influenced by the hours of sleep, rather than what time the subjects "go-to-bed" or "get-up". The response to "Do you wake up often during the night?" expressed an actual situation, well. 2) For subjective cognition regarding excretion, the answer for "constipation" was associated with the number of defecation per week, though the answer for "diarrhea" was not. 3) The answer to "Do you eat breakfast?" reflected the actual situation. However, the answer for "Do you eat between meals?" did not express the actual situation, that is, even the subjects who answered "occasionally" or "I don't eat between meals" had eaten between meals 6.1 times per week, on average. 4) There were mutual influences among sleeping, eating breakfast and excretion.     

Inhibition of cytokine production and arachidonic acid metabolism by eucalyptol (1.8-cineole) in human blood monocytes in vitro

The authors implanted to a group of 10 patients incontinent after prostate surgery (on account of BPH and adenocarcinoma) an artificial AMS 800 sphincter. After a mean follow-up period of 29 months they evaluate based on a questionnaire the therapeutic effect and its influence on the patients quality of life as well as the adequacy of the approval procedure of indication on the part of the insurance company as it influences the quality of life. The effect of treatment and influence on quality of life is evaluated without exception very highly while the approval process is evaluated negatively. The authors draw attention to the risk of suicide in mentally otherwise sound subjects due to unsatisfactory solution of urinary incontinence. Correctly indicated treatment by an artificial sphincter can achieve very satisfactory results. The approval procedure must combine medical and rational aspects, it must be however revised, incl. the economic aspects of the system of health services.     

Evaluation of quality of life in oncology

Studies of quality of life are more and more becoming an integral part of cancer care in situations when treatment of cancer patients is burdened with significant toxicity, and results of survival of these patients are unsatisfactory. Modern concept of health-related quality of life measurement means consensus about its two basic features: multidimensionality of concept, and essentially subjective experience in a treated person. As a minimum, domains of physical, psychological and social are assessed, and the patient is considered to be the primary source of information. The most widely used instruments for quality of life assessment are questionnaires, especially developed for cancer patients, with supplemental items for particular diagnosis. These instruments must satisfy the basic psychometric properties-validity and reliability. Quality of life studies are focused mostly on phase III trials, where differences between treatment arms for tumour response and survival are expected to be small. Another approach is developed in parallel which, based upon quality of life measurement, initiates decisions for the treatment of a set of patients up to health policy level. In these "cost-utility" studies, efficacy and cost of the treatment, and improvement of patients' quality of life are independently estimated, and then integrated in medical decision making.     

Development of the multidimensional index of life quality. A quality of life measure for cardiovascular disease

OBJECTIVES: The purpose of this study was to design a multidimensional measure of health-related quality of life appropriate for patients with cardiovascular disease that was psychometrically sound, brief, and easy to administer. METHODS: Qualitative interviews conducted with healthy subjects and patients with cardiovascular diseases identified nine major quality of life domains. Based on the responses of 129 cardiovascular disease patients recruited from hospitals and clinics, a criterion-based approach was used to select 35 questionnaire items that best tapped these domains. Psychometric properties of the Multidimensional Index of Life Quality (MILQ) were tested with a sample of 348 patients with various cardiovascular diseases. RESULTS: Cronbach's alpha was 0.76 or higher for eight of the nine MILQ domains. Test-retest reliability coefficients were 0.73 or greater in all but two domains. Individual domain scores as well as a weighted overall quality of life index were correlated highly with self-assessed health and the number of heart-related symptoms. CONCLUSIONS: The Multidimensional Index of Life Quality is a psychometrically reliable and valid instrument for measuring quality of life in patients with cardiovascular diseases. The MILQ also may be a suitable measure for other types of chronic diseases.     

Development of a disease-specific health-related quality of life questionnaire for sleep apnea

The Calgary Sleep Apnea Quality of Life Index (SAQLI) was developed to record key elements of the disease that are important to patients. All items felt to influence the quality of life of these patients were identified. Final questionnaire items were selected by interviewing 113 patients with sleep apnea and 50 snorers who rated each item on whether it was a problem and the importance of it to their overall quality of life. Items for the final questionnaire were selected based on the rank order of the frequency ximportance product. The rank ordering was similar across strata of disease severity and between sexes. The Calgary SAQLI has 35 questions organized into four domains: daily functioning, social interactions, emotional functioning, and symptoms. A fifth domain, treatment-related symptoms, can be added for clinical intervention trials to record the possible negative impacts of treatment. The SAQLI has a high degree of internal consistency, face validity as judged by content experts and patients, and construct validity as shown by its positive correlations with the SF-36 and the improvement in scores in patients successfully completing a 4-wk trial of continuous positive airway pressure. It includes items shown to be important to patients with sleep apnea and is designed as a measure of outcome in clinical trials in sleep apnea. Flemons WW, Reimer MA. Development of a disease-specific health-related quality of life questionnaire for sleep apnea.     

The development of an instrument for assessing the quality of life of people with diabetes. Diabetes-39

OBJECTIVES: The aim of this 2-year research project was to develop an instrument specifically designed to assess the quality of life of people with diabetes. METHODS: The project was divided into two phases. In the first phase, information from a detailed literature review, from existing quality-of-life instruments, and from interviews with health professionals and people with diabetes was used to develop an initial instrument of 92 items considered to address important aspects of patients' lives. This questionnaire was mailed to 1,000 people with diabetes, and data from the 516 respondents were used to select the most important and useful items. Fifty items were excluded, leaving 42 items that constituted the pilot instrument. During phase 2, the pilot instrument was used to assess the quality of life of 427 diabetic patients who completed the revised questionnaire. After analyzing this data, three additional items were dropped. The final instrument consists of 39 items and covers five dimensions of patients' lives: Energy and Mobility, Diabetes Control, Anxiety and Worry, Social Burden, and Sexual Functioning. RESULTS: The results of validity and reliability tests conducted to date testify to the relevance of the 39-item questionnaire (Diabetes-39) as a valid discriminative instrument, one which shows significant correlations with an overall quality-of-life assessment, the pattern of diabetes severity, and comorbidity. Further, the results from Diabetes-39 correlate well with the results from the established generic quality-of-life instrument, the Medical Outcomes Study 36-Item Short-Form Health Survey. CONCLUSIONS: Validation of a quality-of-life instrument, however, is an ongoing process. Further research is required to corroborate these early findings and to ensure that this is an instrument that can capture data of greatest relevance to the diabetic patient and that is responsive to change in quality of life.     

Effect of various methods of treatment in chronic renal insufficiency on the quality of life in patients

Interest in measuring the quality of life (QL) in relation to health care has increased enormously in recent years. This is also true for end-stage renal failure where it is important not only to provide a better survival but also the quality of that survival. The aim of this study was to assess the relative influence of different kinds of treatment on end-stage renal disease after the patients' evaluation of their overall QL. We studied 167 patients receiving conservative treatment (45), haemodialysis (44), haemodialysis and erythropoieth (36), and continuous ambulatory peritoneal dialysis (42). The patients completed an original questionnaire consisting of 37 questions divided in five groups and generating 15 QL variables: personal data (name, gender, age, basic kidney disease); sociodemographic data influenced by the illness (family history, working ability, employment status); general health characteristics (fatigue, appetite, wound healing, sleep, resistance to cold); aspects of private life that are mostly influenced by the disease (social interaction, traveling, mood, sports, sexual life), and patients subjective assessment of their condition (self care and happiness). Patients on haemodialysis showed lower levels of QL than that on peritoneal dialysis related to fatigue (p < 0.01), working ability (p < 0.05), wound healing (p < 0.05), and appetite (p < 0.01) compared to the conservative treatment. Peritoneal dialysis had also a statistically significant positive influence on fatigue (p < 0.05) compared to conservative treatment. However, erythropoletin treatment showed better results with regard to traveling (p < 0.05), resistance to cold (p < 0.01), self care (p < 0.05) and mood (p < 0.05) compared to peritoneal dialysis, and working ability (p < 0.05), fatigue (p < 0.05) and mood (p < 0.05) compared to conservative treatment and haemodialysis.     

The MOS SF-36 health survey questionnaire in severe chronic airflow limitation: comparison with the Nottingham Health Profile

This study documents the cross-sectional, health-related quality of life (HRQOL) measures obtained at baseline for patients with severe chronic airways limitation (CAL) being assessed for home oxygen therapy (HOT) at the Flinders Medical Centre, Adelaide, South Australia. Two generic quality of life instruments, the Nottingham Health Profile (NHP) and the Medical Outcomes Study (MOS) short form 36-item questionnaire (SF-36), were administered by interview to the same patients to permit comparisons to be made between the two instruments. SF-36 mean scores were also compared with scores obtained in separate studies of a South Australian elderly general population and of groups of Australian subjects with various medical and psychiatric conditions. NHP mean scores were compared with scores from an elderly group of Adelaide residents from a household survey. HRQOL measures were obtained for 60 patients, 32 males and 28 females. At assessment for HOT, patients with severe CAL were experiencing severe impairment in their quality of life in comparison to age-matched South Australian norms, with physical disability the major limitation. There were several significant correlations between the domains of the SF-36 and the NHP which were predominantly gender-specific. Only small decrements in mental health were found with the SF-36 questionnaire. The SF-36 and the NHP appear to provide discrepant information for severely disabled CAL patients for the subjective domains of emotional and mental health.     

Quality of life: perception of lung cancer patients

An investigation was carried out to examine what quality of life means to lung cancer patients. 200 patients with either lung cancer (108) or chronic respiratory disease (92) were interviewed using a short open-ended questionnaire. They were asked to define quality of life in general, identify what they considered to be a good quality of life for themselves and to rank the relative importance attached to each nominated item. A content analysis was carried out and patients' responses were categorised into eight items. These were: ability to do what one wants to do/work, enjoyment of life, family life, financial security, happiness, health, living longer and social life/leisure activities. Of these, health (42%), enjoyment of life (25%) and family life (24%) were the three most nominated items as definition of quality of life in general. Patients perceived a good quality of life for themselves differently. Family life (58%), health (51%) and social life (43%) were found to be the most nominated components of a good quality of life for the patients. Overall, patients ranked family life and health as the first or second most important factors. There were no significant differences between cases and controls. The study results are challenging and serve to remind us that the term quality of life is misused in many studies. Most existing measures do not encompass the wider aspects of quality of life identified here, but rather concentrate on the "health-related" aspects of quality of life. To achieve this, the research into the best ways of measuring and assessing quality of life must continue to seek individual values and preferences and how these can be applied in a simple way in clinical studies.     

Induction of immunity in the respiratory tract and protection from bovine herpesvirus type 1 infection by different routes of immunization with recombinant adenovirus

As part of a larger study, the Lehman Quality of Life Interview (QOLI) was conducted a total of 85 times with 55 clients with serious mental illness. Results revealed widespread adverse objective circumstances (unemployment, poverty and social isolation) despite which most clients rated their satisfaction levels about average (about equally satisfied and dissatisfied). As expected, subjective quality of life indicators were generally better predictors of global well-being (GWB) (itself based on subjective ratings) than were objective indicators. Correlations between objective and subjective indicators were very low and insignificant. Moderate relationships were found between GWB and levels of personal functioning, and changes in levels of personal functioning, as rated by mental health workers. Retests showed that subjective quality of life was relatively stable over intervals of several months. The findings suggest that leisure and social relations would be suitable areas for interventions that might improve clients' quality of life.     

Value of results of animal experiments for the evaluation of drugs. 3. Animal trials and subjective probability

Inasmuch as the findings in pharmacology and toxicology are based on animal trials these disciplines have to be considered as subjective sciences, since the experimentally obtained objective data become medically relevant only on the basis of subjective probabilities. The value of pharmacological and toxicological tests is dependent on the quality of the investigator. Data obtained in animals trials are of no relevance for human medicine unless the investigator substantiates his subjective probabilities and at the same time demonstrates how the hypotheses won in animal trials can be verified in man. Toxicological testing methods allowing the "preselection" of drugs or any other kind of deductions without verification in man do not exist. Animal studies which are not based on the principles of decision theory serve merely as an alibi and may lead to wrong conclusions. Besides, they interfere with the German Animal Protection Law. Methodological problems can neither be solved by normative regulations of an administrative authority nor by increasing experimental activity.     

Artificial neural networks for the identification of the differences between "light" and "heavy" alcoholics, starting from five nonlinear biological variables

This article makes a comparison among three types of evaluation systems based on a set of data composed of "heavy" alcoholics and "light" alcoholics. The three systems are: 1) a system based on genetic algorithms called BEAGLE; b) seven different types of Artificial Neural Networks; c) a metasystem called MetaNet. The technical aim was to compare the classification capability of these three systems in terms of two classes ("heavy" alcoholics and "light" alcoholics). From the results obtained, the MetaNet system stand out. Globally, it has the best result, followed by the two Artificial Neural Networks, Squash and Logicon Projection. The results obtained prove that the advanced elaboration data systems applied in the social and health fields can be employed in prevention programs having an aim to reduce the social impact of certain pathologies correlated with different kinds of dependence.     

Functional status and well-being in a placebo-controlled trial of zidovudine in early symptomatic HIV infection

To determine the effect of zidovudine on functional status and well-being in patients with early symptomatic human immunodeficiency virus (HIV) infection, 70 subjects in a randomized, placebo-controlled trial (ACTG Protocol 016) were observed for 1 year using a brief quality-of-life questionnaire. Thirty-four subjects were assigned to placebo and 36 subjects to zidovudine, 200 mg orally every 4 h (1,200 mg daily). Functional status and well-being were measured every 3 months using a 30-item self-administered questionnaire derived from health ratings from the Medical Outcomes Study. The mean changes from baseline for zidovudine versus placebo groups were compared using paired and two-sample t tests. Subjects receiving a placebo reported better quality of life compared to baseline than subjects receiving zidovudine at 24 weeks for all dimensions of well-being, including overall health, energy, mental health, health distress, pain, and quality of life. The difference between the two groups' changes from baseline for overall health was 11.5 points on a 100-point scale (p = 0.02), and 11.1 points for energy (0.002). There were no differences between changes from baseline along various dimensions of functional status (physical, social, role, and cognitive function). At 52 weeks both groups reported worse overall health than at baseline, and changes in scores were more similar for the two groups. Although zidovudine has previously been demonstrated to delay progression of disease for patients with mildly symptomatic HIV infection, early in treatment the net effect of a 1,200 mg daily dose of zidovudine may diminish patients' subjective well-being.(ABSTRACT TRUNCATED AT 250 WORDS)     

Age and Subjective Well-Being Revisited: A Discrepancy Perspective.

The hypothesis that the age effect on subjective well-being was entirely mediated by goal discrepancies (GDs) was tested with structural equation modeling. Six GDs grouped into 3 broad categories (relationships, health, and others) were differentially related to age. Whereas GD relationships and GD others (e.g., materials) decreased with age, GD health increased with age. GD health had smaller effects on subjective well-being than GDs in relationships and other life domains. Hence, the net effect of all the GDs on well-being was positive. GD variations because of age could completely explain the age trends in life satisfaction and positive affect, and partially the age trend in negative affect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)